Acute, total occlusion of the left main stem: Coronary intervention options, outcomes, and recommendations

I. Édes, Zoltán Ruzsa, Árpád Lux, L. Gellér, Levente Molnár, Fanni Nowotta, Márta Csilla Kerülõ, Dávid Becker, B. Merkely

Research output: Contribution to journalArticle

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Abstract

Introduction: Acute, total occlusion of the unprotected left main stem (uLMo) in acute coronary syndrome (ACS) patients is a catastrophic event often accompanied by sudden cardiac death (SCD) and/or cardiogenic shock (CS) with high mortality rates and limited methods of successful treatment. Emergent, surgical and percutaneous revascularization has been reported before, yet comprehensive data remains scarce. Aim: To examine emergency percutaneous coronary intervention (PCI) outcomes in ACS cases presenting with uLMo. Material and methods: Data on 23 subjects undergoing primary PCI in uLMo cases were analyzed. The primary end-point was in-hospital death; secondary end-points were successful salvage of coronary anatomy and 90-day major cardiac adverse events (MACE). Results: About 40% of LM occlusion cases presented following successful on-site cardio-pulmonary resuscitation (CPR). Of all patients arriving for treatment the occluded LM was successfully opened and stented in ~90% of cases. CS was present in >85% of cases, and circulatory support in the form of intra-aortic balloon pump and/or extracorporeal membrane oxygenation systems was applied in every eligible case (~80%). The in-hospital death rate was 56%, mostly including individuals requiring prior CPR. At 6 months, additional MACE rates were low at 8.7%. Conclusions: We found that uLMo ACS cases often present with preceding CPR and mostly in manifest CS. Coronary salvage is generally successful, yet uLMo even with optimal present day complex treatment yields quite high mortality rates. This is especially true for patients receiving prior CPR. In surviving patients, however, 6-month MACE rates are acceptable.

Original languageEnglish
Pages (from-to)233-239
Number of pages7
JournalPostepy w Kardiologii Interwencyjnej
Volume14
Issue number3
DOIs
Publication statusPublished - Jan 1 2018

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Cardiopulmonary Resuscitation
Cardiogenic Shock
Acute Coronary Syndrome
Percutaneous Coronary Intervention
Mortality
Extracorporeal Membrane Oxygenation
Sudden Cardiac Death
Anatomy
Emergencies
Therapeutics

Keywords

  • Acute myocardial infarction/STEMI
  • Coronary occlusion
  • Left main coronary disease
  • Percutaneous coronary intervention

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Acute, total occlusion of the left main stem : Coronary intervention options, outcomes, and recommendations. / Édes, I.; Ruzsa, Zoltán; Lux, Árpád; Gellér, L.; Molnár, Levente; Nowotta, Fanni; Kerülõ, Márta Csilla; Becker, Dávid; Merkely, B.

In: Postepy w Kardiologii Interwencyjnej, Vol. 14, No. 3, 01.01.2018, p. 233-239.

Research output: Contribution to journalArticle

Édes, I. ; Ruzsa, Zoltán ; Lux, Árpád ; Gellér, L. ; Molnár, Levente ; Nowotta, Fanni ; Kerülõ, Márta Csilla ; Becker, Dávid ; Merkely, B. / Acute, total occlusion of the left main stem : Coronary intervention options, outcomes, and recommendations. In: Postepy w Kardiologii Interwencyjnej. 2018 ; Vol. 14, No. 3. pp. 233-239.
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abstract = "Introduction: Acute, total occlusion of the unprotected left main stem (uLMo) in acute coronary syndrome (ACS) patients is a catastrophic event often accompanied by sudden cardiac death (SCD) and/or cardiogenic shock (CS) with high mortality rates and limited methods of successful treatment. Emergent, surgical and percutaneous revascularization has been reported before, yet comprehensive data remains scarce. Aim: To examine emergency percutaneous coronary intervention (PCI) outcomes in ACS cases presenting with uLMo. Material and methods: Data on 23 subjects undergoing primary PCI in uLMo cases were analyzed. The primary end-point was in-hospital death; secondary end-points were successful salvage of coronary anatomy and 90-day major cardiac adverse events (MACE). Results: About 40{\%} of LM occlusion cases presented following successful on-site cardio-pulmonary resuscitation (CPR). Of all patients arriving for treatment the occluded LM was successfully opened and stented in ~90{\%} of cases. CS was present in >85{\%} of cases, and circulatory support in the form of intra-aortic balloon pump and/or extracorporeal membrane oxygenation systems was applied in every eligible case (~80{\%}). The in-hospital death rate was 56{\%}, mostly including individuals requiring prior CPR. At 6 months, additional MACE rates were low at 8.7{\%}. Conclusions: We found that uLMo ACS cases often present with preceding CPR and mostly in manifest CS. Coronary salvage is generally successful, yet uLMo even with optimal present day complex treatment yields quite high mortality rates. This is especially true for patients receiving prior CPR. In surviving patients, however, 6-month MACE rates are acceptable.",
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T1 - Acute, total occlusion of the left main stem

T2 - Coronary intervention options, outcomes, and recommendations

AU - Édes, I.

AU - Ruzsa, Zoltán

AU - Lux, Árpád

AU - Gellér, L.

AU - Molnár, Levente

AU - Nowotta, Fanni

AU - Kerülõ, Márta Csilla

AU - Becker, Dávid

AU - Merkely, B.

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Introduction: Acute, total occlusion of the unprotected left main stem (uLMo) in acute coronary syndrome (ACS) patients is a catastrophic event often accompanied by sudden cardiac death (SCD) and/or cardiogenic shock (CS) with high mortality rates and limited methods of successful treatment. Emergent, surgical and percutaneous revascularization has been reported before, yet comprehensive data remains scarce. Aim: To examine emergency percutaneous coronary intervention (PCI) outcomes in ACS cases presenting with uLMo. Material and methods: Data on 23 subjects undergoing primary PCI in uLMo cases were analyzed. The primary end-point was in-hospital death; secondary end-points were successful salvage of coronary anatomy and 90-day major cardiac adverse events (MACE). Results: About 40% of LM occlusion cases presented following successful on-site cardio-pulmonary resuscitation (CPR). Of all patients arriving for treatment the occluded LM was successfully opened and stented in ~90% of cases. CS was present in >85% of cases, and circulatory support in the form of intra-aortic balloon pump and/or extracorporeal membrane oxygenation systems was applied in every eligible case (~80%). The in-hospital death rate was 56%, mostly including individuals requiring prior CPR. At 6 months, additional MACE rates were low at 8.7%. Conclusions: We found that uLMo ACS cases often present with preceding CPR and mostly in manifest CS. Coronary salvage is generally successful, yet uLMo even with optimal present day complex treatment yields quite high mortality rates. This is especially true for patients receiving prior CPR. In surviving patients, however, 6-month MACE rates are acceptable.

AB - Introduction: Acute, total occlusion of the unprotected left main stem (uLMo) in acute coronary syndrome (ACS) patients is a catastrophic event often accompanied by sudden cardiac death (SCD) and/or cardiogenic shock (CS) with high mortality rates and limited methods of successful treatment. Emergent, surgical and percutaneous revascularization has been reported before, yet comprehensive data remains scarce. Aim: To examine emergency percutaneous coronary intervention (PCI) outcomes in ACS cases presenting with uLMo. Material and methods: Data on 23 subjects undergoing primary PCI in uLMo cases were analyzed. The primary end-point was in-hospital death; secondary end-points were successful salvage of coronary anatomy and 90-day major cardiac adverse events (MACE). Results: About 40% of LM occlusion cases presented following successful on-site cardio-pulmonary resuscitation (CPR). Of all patients arriving for treatment the occluded LM was successfully opened and stented in ~90% of cases. CS was present in >85% of cases, and circulatory support in the form of intra-aortic balloon pump and/or extracorporeal membrane oxygenation systems was applied in every eligible case (~80%). The in-hospital death rate was 56%, mostly including individuals requiring prior CPR. At 6 months, additional MACE rates were low at 8.7%. Conclusions: We found that uLMo ACS cases often present with preceding CPR and mostly in manifest CS. Coronary salvage is generally successful, yet uLMo even with optimal present day complex treatment yields quite high mortality rates. This is especially true for patients receiving prior CPR. In surviving patients, however, 6-month MACE rates are acceptable.

KW - Acute myocardial infarction/STEMI

KW - Coronary occlusion

KW - Left main coronary disease

KW - Percutaneous coronary intervention

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